The management of pancreatic pseudocysts was reviewed in 41 patients, 28 of whom were treated surgically, 9 by non-surgical percutaneous drainage and 4 expectantly. In 20 patients an internal drainage was created and in 15 an external drainage. Hospital mortality was 2% (1/41) and postoperative mortality 4% (1/28). External drainage was associated with 40% early complications and 33% recurrent cysts or chronic internal or external fistulas; the corresponding figures for internal drainage were 15% and 5%, respectively. The 4 patients who were managed expectantly with disappearance of the cysts had an uneventful course. The advent of ultrasound and computerized tomography (CT) has been of great diagnostic value. As external drainage proved inferior to internal drainage in the present study, percutaneous puncture guided by ultrasound or CT and creation of non-operative external drainage is not a recommended treatment. Expectant management with repeated ultrasound examinations may be chosen in selected cases.